The effects of medical tourism: Thailand’s experience

OBJECTIVE: To explore the positive and negative effects of medical tourism on the economy, health staff and medical costs in Thailand. METHODS: The financial repercussions of medical tourism were estimated from commerce ministry data, with modifications and extrapolations. Survey data on 4755 foreign and Thai outpatients in two private hospitals were used to explore how medical tourism affects human resources. Trends in the relative prices of caesarean section, appendectomy, hernia repair, cholecystectomy and knee replacement in five private hospitals were examined. Focus groups and in-depth interviews with hospital managers and key informants from the public and private sectors were conducted to better understand stakeholders' motivations and practices in connection with these procedures and learn more about medical tourism. FINDINGS: Medical tourism generates the equivalent of 0.4% of Thailand's gross domestic product but has exacerbated the shortage of medical staff by luring more workers away from the private and public sectors towards hospitals catering to foreigners. This has raised costs in private hospitals substantially and is likely to raise them in public hospitals and in the universal health-care insurance covering most Thais as well. The "brain drain" may also undermine medical training in future. CONCLUSION: Medical tourism in Thailand, despite some benefits, has negative effects that could be mitigated by lifting the restrictions on the importation of qualified foreign physicians and by taxing tourists who visit the country solely for the purpose of seeking medical treatment. The revenue thus generated could then be used to train physicians and retain medical school professors

Childhood stunting in Thailand: when prolonged breastfeeding interacts with household poverty

Abstract Background Childhood stunting, defined as the height-for-age standardized score lower than minus two, is one of the key indicators for assessing well-being and health of a child; and can be used for monitoring child health inequalities. Thailand has been successful in improving health and providing financial protection for its population. A better understanding of the determinants of stunting will help fill both knowledge and policy gaps which promote children’s health and well-being. This study assesses the factors contributing to stunting among Thai children aged less than five years. Methods This study obtained data from the Multiple Indicator Cluster Survey Round 4 (MICS4), conducted in Thailand in 2012. Data analysis consisted of three steps. First, descriptive statistics provided an overview of data. Second, a Chi-square test determined the association between each covariate and stunting. Finally, multivariable logistic regression assessed the likelihood of stunting from all independent variables. Interaction effects between breastfeeding and household economy were added in the multivariable logistic regression. Results In the analysis without interaction effects, while the perceived size of children at birth as ‘small’ were positively associated with stunting, children in the well-off households were less likely to experience stunting. The analysis of the interactions between ‘duration of breastfeeding’ and ‘household’s economic level’ found that the odds of stunting in children who were breastfed longer than 12 months in the poorest household quintile were 1.8 fold (95% Confidence interval: 1.3–2.6) higher than the odds found in mothers from the same poorest quintiles, but without prolonged breastfeeding. However prolonged breastfeeding in most well-off households (those between the second quintile and the fifth wealth quintile) did not show a tendency towards stunting. Conclusions Childhood stunting was significantly associated with several factors. Prolonged breastfeeding beyond 12 months when interacting with poor economic status of a household potentiated stunting. Children living in the least well-off households were more prone to stunting than others. We recommend that the MICS survey questionnaire be amended to capture details on quantity, quality and practices of supplementary feeding. Multi-sectoral nutrition policies targeting poor households are required to address stunting challenges

Budget impact analysis of the new reimbursement policy for day surgery in Thailand

Rapeepong Suphanchaimat,1,2 Jutatip Thungthong,3 Kriddhiya Sriprasert,3 Kanjana Tisayaticom,1 Chulaporn Limwattananon,4 Supon Limwattananon4 1International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand; 2Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand; 3National Health Security Office, Bangkok, Thailand; 4Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand Introduction: In 2017 the Thai Ministry of Public Health proposed a new financing mechanism to promote day surgery under the Universal Coverage Scheme – the main public insurance arrangement for Thais. The key feature of the policy is health facilities performing day surgery can claim the treatment expense based on relative weight (RW) instead of adjusted RW (adjRW). Procedures for 12 diseases (so-called “candidate procedures”) are eligible for the new reimbursement. The objective of this study was to assess the current day surgery situation in Thailand and analyze potential budget impact from the new policy.Methods: A quantitative cross-section design was employed. Individual inpatient records of the Universal Coverage Scheme during 2014–2016 were analyzed. Descriptive statistics and simulation analyses were applied. The analyses were divided into three subtopics: 1) case volume and expense claim, 2) utilization across facilities, and 3) case mix index and budget impact.Results: Overall, day surgery accounted for 4.8% of admissions with candidate procedures. Inguinal hernias, hemorrhoids, and common bile duct stones caused the largest sum of admission numbers and admission days. Currently, the annual reimbursement for candidate procedures treated as inpatient cases is around 290.8 million Baht (US$8.8 million), with about 12.4 million Baht (US$ 0.38 million) for day surgery cases. If all candidate procedures were performed as day surgery and diagnostic-related groups (DRG) version 6 was applied, the incremental budget would amount to 1.9 million Baht (US$ 58,903).Conclusions: The new reimbursement policy will likely lead to minimal budget burden. Even in the case of maximal uptake of the policy, the needed budget would increase by just 15%. The marginal budget increment was explained by the infinitesimal RW–adjRW difference. Apart from the financial measure, other qualitative aspects of the policy, such as infrastructure and health staff readiness, should be explored. Keywords: day surgery, inpatient, budget impact, case mix index, Thailan

The incidence of public spending on healthcare: Comparative evidence from Asia

The article compares the incidence of public healthcare across 11 Asian countries and provinces, testing the dominance of healthcare concentration curves against an equal distribution and Lorenz curves and across countries. The analysis reveals that the distribution of public healthcare is prorich in most developing countries. That distribution is avoidable, but a propoor incidence is easier to realize at higher national incomes. The experiences of Malaysia, Sri Lanka, and Thailand suggest that increasing the incidence of propoor healthcare requires limiting the use of user fees, or protecting the poor effectively from them, and building a wide network of health facilities. Economic growth may not only relax the government budget constraint on propoor policies but also increase propoor incidence indirectly by raising richer individuals' demand for private sector alternatives. © 2007 Oxford University Press.link_to_subscribed_fulltex

Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data

Background: Conventional estimates of poverty do not take account of out-of-pocket payments to finance health care. We aimed to reassess measures of poverty in 11 low-to-middle income countries in Asia by calculating total household resources both with and without out-of-pocket payments for health care. Methods: We obtained data on payments for health care from nationally representative surveys, and subtracted these payments from total household resources. We then calculated the number of individuals with less than the internationally accepted threshold of absolute poverty (US$1 per head per day) after making health payments. We also assessed the effect of health-care payments on the poverty gap-the amount by which household resources fell short of the$1 poverty line in these countries. Findings: Our estimate of the overall prevalence of absolute poverty in these countries was 14% higher than conventional estimates that do not take account of out-of-pocket payments for health care. We calculated that an additional 2·7% of the population under study (78 million people) ended up with less than $1 per day after they had paid for health care. In Bangladesh, China, India, Nepal, and Vietnam, where more than 60$1 per day need to include measures to reduce such payments. © 2006 Elsevier Ltd. All rights reserved.link_to_subscribed_fulltex

Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data

Background: Conventional estimates of poverty do not take account of out-of-pocket payments to finance health care. We aimed to reassess measures of poverty in 11 low-to-middle income countries in Asia by calculating total household resources both with and without out-of-pocket payments for health care. Methods: We obtained data on payments for health care from nationally representative surveys, and subtracted these payments from total household resources. We then calculated the number of individuals with less than the internationally accepted threshold of absolute poverty (US$1 per head per day) after making health payments. We also assessed the effect of health-care payments on the poverty gap-the amount by which household resources fell short of the$1 poverty line in these countries. Findings: Our estimate of the overall prevalence of absolute poverty in these countries was 14% higher than conventional estimates that do not take account of out-of-pocket payments for health care. We calculated that an additional 2·7% of the population under study (78 million people) ended up with less than $1 per day after they had paid for health care. In Bangladesh, China, India, Nepal, and Vietnam, where more than 60$1 per day need to include measures to reduce such payments. © 2006 Elsevier Ltd. All rights reserved.link_to_subscribed_fulltex