Government Spending And Central Local Relations In Thailands Health Sector

This discussion paper is one of five discussion papers for the Thailand public financial management report. It focuses on efficiency and equity in the financing of health services, and the evolving role of central and local government in the health sector. Over the last few decades, Thailand has seen significant improvements in health outcomes, reflecting sustained public investment in both infrastructure and human resources. Thailand has also succeeded in expanding the coverage of health protection schemes, culminating in the introduction of the Universal Coverage (UC) scheme in 2001. These efforts have broadened access to health services, contributed to greater and more equitable utilization, and helped reduce the financial burden and the risk of impoverishment associated with health care expenses. However, there are fewer data on broader measures of health system performance, including dimensions of quality. Overall, available evidence suggests a mixed picture. For instance, while there has been improvement in the management of chronic conditions, a significant number of cases remain undiagnosed or untreated. Similarly, Thailand has seen recent improvement in 2-year survival rates from cancer and heart attacks, but still lags far behind Organization for Economic Co-operation and Development (OECD) countries. While the achievements of Thailand's health system are undeniable, this paper highlights three key challenges: (i) inequalities in utilization and spending; (ii) mounting cost pressures; and (iii) fragmentation of financing and unresolved issues concerning the respective roles of central and local government. This paper provides evidence of regional differences in diagnosis and management of chronic disease, and of survival rates from cancer and heart attacks. These data do not suggest a strong relationship between the health system and spending on the one hand, and on quality or health outcomes on the other. Indeed, efficiency may be a greater concern, with over-provision now a growing problem in some parts of the health system. However, more evidence is needed on these issues. For example, while high levels of spending and utilization in the Civil Servant Medical Benefit Scheme (CSMBS) are often noted, it is less clear whether this is associated with better outcomes (e.g. higher cancer survival rates or improved health outcomes for the elderly). The implications of geographic disparities in spending in the Social Security Scheme (SSS) and the CSMBS also warrant further attention.

Addressing regional disparities in access to public services is an emerging development challenge for Thailand. A well-functioning system of Central-Local Government Relations and proactive expenditure policy can help achieve this goal. Providing responsive and accountable public services are necessary for maintaining trust of the citizens in government and fostering cohesion within a unitary state like Thailand. Without a reversal of current regional disparities in access to public services and addressing tensions that are present in the central-local architecture, Thailand runs the risk of eroding public trust in government and leading to further polarization. Thailand has a significant opportunity to improve delivery of public services by: (i) making access to public services more uniform across the country; (ii) transitioning fully to a unitary decentralized form of government with clearly demarcated roles and accountability structures between different levels of government (especially within health and education sectors) and to administratively consolidate Laos into larger more financially viable entities; and (iii) establishing national service delivery standards, publishing annual performance reports on these benchmarks along with unit costs of standard goods and supplies procured, and publishing reports on operations at the municipal level.

Sustainable and inclusive growth in emerging Asian economies requires high levels of public investment in areas such as infrastructure, education, health, and social services. The increasing complexity and regional diversity of these investment needs, together with the trend of democratization, has led to fiscal decentralization being implemented in many Asian economies. This book takes stock of some major issues regarding fiscal decentralization, including expenditure and revenue assignments, transfer programs, and sustainability of local government finances, and develops important findings and policy recommendations.

Thailand has made impressive economic and social progress over several decades. However, the COVID-19 crisis has interrupted this progress. Thanks to its sound macroeconomic policy framework, Thailand was well placed to respond rapidly to the sharp economic downturn. Nevertheless, achieving high-income country status will require, in addition to a strong recovery programme, a set of policy reforms focused on productivity growth and human capital accumulation. Thailand has made remarkable progress in expanding access to education, and the share of highly educated workers has increased significantly. Nevertheless, because of skills mismatches, substantial labour shortages have prevailed in a range of occupations and industries, which makes it important to improve vocational education and adult training programmes. As the demand for services has become important globally, Thailand has an opportunity to boost its exports of services, diversify its economic activity, and therefore become more resilient in the face of unexpected shocks. This would involve a focus on digital services and business-to-business services, which represent a large share of the value of manufacturing products. Focus on human capital, skills, digital technology, and high-value services would help Thailand resume strong economic growth and social progress after the COVID-19 crisis. SPECIAL FEATURES: HUMAN CAPITAL; TRADE IN SERVICES

The health systems we enjoy today, and expected medical advances in the future, will be difficult to finance from public resources without major reforms. Public health spending in OECD countries has grown rapidly over most of the last half century. These spending increases have contributed to ...

This report discusses several different approaches that support reforming health care services in developing countries. For some time now, health care services have been supported by government funds. As demands for improving health care services continue to increase additional demands will be placed on governments to respond. This, however, will not be easy. Slow economic growth and record budget deficits in the 1980's have forced reductions in public spending. Alternative approaches to finance health care services are needed. Such possible changes could involve: decentralization of federal government involvement; the promotion of nongovernment involvement; the imposition of user fees; and, establishing health insurance. Finally, the role of the Bank in pursuing new financing strategies is discussed.

Local budgeting serves important functions that include setting priorities, planning, financial control over inputs, management of operations and accountability to citizens. These objectives give rise to technical and policy issues that require open discussion and debate. The format of the budget document can facilitate this debate. This book provides a comprehensive treatment of all aspects of local budgeting needed to develop sound fiscal administration at the local level. Topics covered include fiscal administration, forecasting, fiscal discipline, fiscal transparency, integrity of revenue administration, budget formats, and processes including performance budgeting, and capital budgeting.

The rise of globalized business has created a world village wherein ideas and industry transcend national boundaries. Unfortunately, the resulting increase in travel has accelerated the transmission of diseases, generating a surge in worldwide epidemics and increasing the necessity of innovative strategies for prevention, containment, and communication related to global health issues. Transforming Public Health in Developing Nations showcases the latest developments, trends, and challenges within the field of international public health. Featuring empirical studies, case studies, reviews, and discussion notes, this authoritative text highlights diverse, important global health issues, making it an essential resource for professionals, researchers, and academics seeking insight on the latest developments in contemporary healthcare. This reference work highlights a broad scope of current issues including global epidemics, worldwide health systems, mental health issues in developing nations, barriers to healthcare, sanitation and infection, cultural diversity in healthcare administration, cultural perceptions of reproductive health issues, international health costs and budgets, and health information technology.

In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.