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News And Events

Thailand needs more investment in health
 
 
BANGKOK—Thailand needs more investment in health that gives handsome return to national economy, called health experts.

“Investment in health today will reduce health risks in future,” said Natt Hongdilokkul, a postdoctoral fellow of British Columbia Centre for Excellence in HIV/AIDS.

Spoke at a seminar commemorated the International Universal Health Coverage Day on 12 December 2018, at Centra Convention Centre in Chaeng Wattana, Mr Natt raised Thai Universal Health Coverage (UHC) as a good example of investment in health that gave return to overall society and economy.

Currently, around 99.9 per cent of Thai populations are covered by three healthcare schemes---UHC, Social Security scheme and Civil Servant Welfare.

Since its introduction in 2002, the tax-funded UHC has provided health access to over 48.5 million Thai people. It has prevented people from death and catastrophic health expenditure. Some researches found that UHC had reduced infant mortality of 13 to 30 per cent and out-of-pocket expenditure by 28 per cent on average.

Mr Natt’s recent research on economic values generated by UHC indicates that the scheme has increased level of non-medical household consumptions such as food, gas, groceries and entertainment. On another hand, the scheme has also increased life-expectancy by 0.1417 year.

It gives total return 1.73 baht per each baht of government spending, according to his estimation. Two by third of this return value comes from increasing life expectancy.

“Public spending on the UHC is a health investment that paying off,” concluded Mr Natt.

The advantage of investment in health is manifested around the world---through numbers of countries’ health programs including vaccine distributions, health promotion and disease prevention programs.

In Japan, investment in health has increased social capital for economic growth, said Tomohiko Makino, chief advisor for the Partnership Project for Global Health and UHC, the Japan International Cooperation Agency.

Japan introduced UHC in 1961, resulting in rising productivity of healthy workforces that contribute to national economy. Medical industry such as export pharmaceutical and medical technology has generated growth too, said Mr Tomohiko.

Concerning health as human security, Japanese government has implemented global health diplomacy, leading to its engagement with development of health programs in several countries including Thailand.

Another clear example of investment in health's benefit is seen in global funding on HIV and AIDS programs, that have reduced numbers of new HIV-infected people and increased access to anti-retroviral drugs.

According to the Joint United Nations Program on HIV and AIDS (UNAIDS), over 20 billion US$ (656 billion baht) was spent for HIV and AIDS in low- and middle-income countries in 2017, increased from 10 billion US$ (325 billion baht) in 2006.

The sources of finance were varied ranging from domestic public and private funds to international donations and the Global Fund to Fight AIDS, Tubercolosis and Malaria.

There’s the shift from international donor dependency to countries' internal funding distribution in recent years. For example, Thailand has collected sin tax, part of which is spent to fund health program including HIV and AID prevention campaigns run by civil society.The UHC has provided anti-retroviral drugs to beneficiaries, giving them chances to survive and work as ordinary workers.

The consequence of long-year investment in AIDS is the declining of new HIV infections by 47 per cent since the outbreak in 1996. AIDS-related deaths have been reduced by more than 51 per cent since the peak in 2004, according to UNAIDS data.

Investment in AIDS program also helps generate information and data that improve accuracy of epidemiology analysis.

“These are few examples outlining how investment, particularly AIDS, have increased the ability of health system to produce health and non-health outcomes. Investing in AIDS have contributed to health outcomes and to economic growth,” said Reeta Bhatia, Senior Policy Advisor of UNAIDS.

“Though there has been achievement, the progress around the world have been uneven. Many countries like Thailand has a significant progress, including increasing the balance between treatment in HIV and prevention of HIV. But we have others countries that's still far behind.”

There’re major gaps. Around 25 per cent of people living with HIV globally don’t know their status.

“These gaps do not have to do with investment or resources, also have to do with structural barriers like stigma and discrimination, lack of political will to ensure that no one will be left behind. So it’s not away only about money,” said Ms Bhatia.

A research ‘health human capital and economic growth in Sub-Saharan African and OECD countries,’ conducted by Kwabena Gyimah-Brempong and Mark Wilson, suggests that health contributed to 22 per cent and 30 per cent of growth rates of per-capita income in Sub-Saharan African and OECD respectively.

Evidences in some other researches show that health improvement enhance GDP growth rate.

Udomsak Saengow from Center of Excellence in Health System and Medical Research, Walailak University, has been working on a research to find the connection between health access and income levels of UHC beneficiaries.

His team has tracked hundreds thousands unemployed and informal workers within UHC beneficiaries, and compared their health conditions and income levels between the year 2001, a year prior the introduction of UHC, and 2013, the year that UHC system was stable.

Their finding shows that the scheme has improved health conditions of the survey groups. But it’s not clear at this stage whether the workers' improving health contributes to increasing incomes.

“When people have good health, we can assume that their productivity will increase and result in better income. But our survey groups have earned income in levels lower than those of our expectations,” said Dr Udomsak.

“It’s the reality that people who work hard gain lesser income than others who sit still. This goes back to the inequality problem that plagues our society”

Thailand was ranked the world's third most unequal nation by Credit Suisse’s Global Wealth Report 2016, with 58 per cent of the country's wealth controlled by one per cent of people. This year, Thailand climbed up on the first rank, with 66.9 per cent of wealth controlled by the richest one per cent.

The situation shows that investment in health sector alone can't generate growth, unless there's an effort to close the inequality gap in non-health sectors.

As the gap is widening, some doctor groups have called the government to slash the UHC's fund. Its trippling spending in the past 16 years is being blamed for creating financial burden for the nation.

Health expenditure accounts to four per cent of Thai GDP. However, it’s still far lower than other countries with UHC scheme such as Japan (10.9 per cent) UK (9.88 per cent), according to the World Bank data in 2015.

"Thailand can invest more in health. But the government need to prioritize its spending. Could it be possible that priority is given to heath?," said Dr Udomsak.

“The benefit of UHC falls in non-health sectors. Public Health Ministry pays for health access to keep people healthy. So they can work and contribute to economic values in the records of Finance Ministry. If we ignore this connection, investment in health will hardly happen. "