The WHO overall health system performance score places Thailand 47/191 countries. This composite measure of overall health system attainment⁸⁵ is based on a country’s goals relating to health, responsiveness, and fairness in financing. The measure varies widely across countries and is highly correlated with general levels of human development as captured in the human development index.

Figure 3 Total expenditure on health per capita (intl $) shown also as a percentage of GDP

Source: World Health statistics 2007

In 2004, the total per capita expenditure on health care was Intl $293 (3.5% of GDP).⁸⁶ Among the countries of CSE Asia, this figure falls within a spending range of Intl $2,293 in Japan (7.8% of GDP) and Intl $38 in Myanmar (2.2% of GDP). (Figure 3).

Thailand has a stated health care policy that constitutes part of the 9th Economic and Social Development Plan 2002-2006. Its objectives are:

1. To create a proactive health system that aims at promoting healthy conditions, protecting safety of life and health, in terms of food safety and security, environmental and occupational safety, consumer protection and disease prevention.
2. To create a security system for protecting people’s health from the negative impacts of economic, social, and developmental activities, and to create an insurance system for the people to have access to quality health care with universal coverage on an equitable basis, particularly for the poor and underprivileged.
3. To strengthen individuals, families, communities and society to have the potential for self-care and health promotion, using the learning and participatory approach in the setting up and management of health systems.
4. To set up mechanisms and measures for creating, seeking and increasing the potential for screening knowledge and technology for health development, emphasizing research and development in the utilization of international and Thai wisdom in a well-informed manner for self-reliance in health.

These aims are underpinned by a range of targets, implementation strategies and delivery dates.⁸⁷ Country-wide, there are 1,219 hospitals and medical establishments with beds that provide general services. In addition, there are 59 facilities described as ‘specialised services’, 49 Ministry of Public Health facilities and six private institutions. These are staffed by 18,918 physicians, 4,129 dentists, 7,413 pharmacists, 95,834 nurses and 20,263 technical nurses.⁸⁸

A structured system of care provides Thailand’s population with local health centres, district hospitals, provincial hospitals and tertiary referral centres. The ground-breaking 30 baht scheme has brought primary care into sharper focus and the shift in funding from some urban hospitals to local health centres has been designed to make health care accessible to a broader section of the population, which was previously weighted in favour of the urban population. Mills et al comment:

In Thailand, previous experience and investment in health care was essential for implementation of the universal coverage scheme. Over several decades, comprehensive health care coverage had been achieved through developing infrastructure in rural areas, where two thirds of Thailand’s population lives. Although beds (public and private) and doctors are concentrated in Bangkok, successive governments have built up primary health care centres (which do not have doctors or beds) in all sub-districts and community hospitals (10-120 beds) in more than 90% of districts. In addition, an effective administrative system meant that 45 million people could be registered for the universal coverage scheme within four months.⁸⁹

Palliative care services, however, despite being included in Tertiary Prevention and Palliative Care Plan embodied in the Cancer Control Policy of 1997, do not feature in the country’s national health policies – hence the significance attached to the extant discussions between leaders of the Hospice Foundation and the Ministry of Public Health regarding the remit of the 30 baht scheme.