Dr Jadej Thammatacharee, deputy secretary general of the Thai National Health Security Office (NHSO), outlines the evolution of Thailand’s universal healthcare coverage program, the challenges inherent in its implementation, and the Thai government’s commitment to working with industry to overcome them.

 

Can you introduce yourself to our international audience and outline the main objectives of the NHSO?

I have been working for the NHSO for the past 16 years and, since day one, I have been delighted to be part of its journey. I started my career as a medical doctor and I was working in the Ministry of Public Health until 2002. The NHSO is a government organization, created by the National Health Security Act in 2002, under the supervision of the Minister of Public Health. The NHSO has developed a universal healthcare management system that aims to be efficient, knowledge-based, and create health security for every Thai citizen.

 

What key priorities has the NHSO established for 2019 and 2020?

One of the main objectives of the NHSO is to improve the Thai population’s access to high-quality healthcare. We believe that every Thai should feel secure, irrespective of whether they are sick or not. Another objective is prevention and how to prevent people from spending inordinate amounts on their healthcare. When the NHSO was created, only 77 percent of Thais were covered by any public health insurances. We decided to focus on the people without any public health insurance and created a new universal coverage scheme. After 2002, we set a special scheme, that everyone who was born in Thailand should be covered by this universal scheme.

After more than 16 years of hard work, we have achieved our objective and we cover 99 percent of Thai people. Now our main goal is to focus on people who are still not covered by the system. Every Thai has the right to receive health services under law, but in reality, accessibility is an issue. We are putting our efforts into covering the marginal people, such as the elderly, prisoners, monks, and those who do not know their rights, who are not currently covered.

To help these people, we want to find them, convince them to be in our system, and put in place some mechanisms to provide greater accessibility.

 

What are the most significant trends and dynamics that have been impacting the Thai healthcare ecosystem in recent years?

The Thai healthcare ecosystem has faced many challenges in the past few years. The population is rapidly ageing and will have to be able to access treatments, and new technology is entering the healthcare system rapidly. We have to find a way to finance those new treatments and technologies.

We are learning from different countries, like Japan, to carry on investing in technology for the elderly and reduce the costs. We are pushing take on care of the elderly at home or social care access instead of the hospital. These problems are not new, but we need to understand how we can access to new technologies before we implement a new and less costly, system.

 

How are other stakeholders helping to tackle these challenges? Is the industry willing to collaborate with you to find a solution to the pricing conundrum?

At this moment, many companies are involving in the scheme. A few years ago, our scheme was not mature enough, so the companies were not interested in looking deeper. Nowadays, expenditure is quite high, so our relationship with the industry is more developed. Every year, there are many expensive new drugs are coming into the market while new rare diseases are also appearing. People – especially those on the margins – cannot afford the treatments. Our aim is to negotiate with the companies to get the best and affordable price technology and drugs for the patient. It is not an easy task to ensure that the patient has access to the best medicine and that companies can make a profit for their products.

 

The NHSO has reinforced its efforts to combat outbreaks of measles, among other diseases. Is Thailand doing enough in terms of prevention?

Since the beginning, prevention has been one of our main priorities, along with promotion, treatment, and social care.

The pitfall of prevention and promotion is that we have to convince the population to take care of themselves. In the south of Thailand, we had to launch several different vaccination campaigns and convince the population to go to the health centre to get the vaccine because getting the vaccine for them is against to their beliefs and religion. It has been a tough mission. We have to find a solution to distribute the vaccines and change the mindsets of the population. Prevention and promotion are more focused on how to educate the population to get medicine, and we believe that the industry has a role to play.

 

Do you see Thailand doing enough in terms of the digitalization of healthcare?

Healthcare in Thailand is one of the best in the region. We have well-respected doctors who studied abroad, especially in the US or Europe, come back to practice in Thailand. However, we do not have enough workforces to provide enough service. We are convinced that digitalization might help us improve our efficiency. As it is mentioned, we can see that more than 75 percent of the Thai population nowadays has a smartphone, so we are thinking about using smartphone technology in the healthcare ecosystem.

Regarding vaccinations, here in Bangkok, we are experimenting with a new system, whereby the patient will have access to the medical information on an application which including the vaccines they have to take. We cannot deny that technology will have an important role to play in healthcare in the near future. We have to find a way to incorporate these technologies into our field. The private hospitals are promoting new technologies while the public hospitals are already using quite advanced procedures. The government is trying to invest and improve the health service through new technologies also.

 

One of the government’s main objectives is to make Thailand the leading country in the region for clinical trials. How close is the country to realising this goal?

Many organizations, health institutes and companies are trying to create the right climate to encourage and develop the clinical trial ecosystem here in Thailand. We are lucky to have a very strong university hospital system, which can set up clinical trials. We are going to follow this path in the near future since we have the science to launch clinical research.

 

What are the priorities for NHSO for the next 5 years? Where do you see Thailand’s future positioning within the Asia-Pacific region?

Thailand’s healthcare system is quite competitive compared to other countries in the region. The quality is acceptable, and we are trying to keep the price affordable and not so high. We have to continue working to surmount challenges such as the ageing population, the unequal distribution of doctors, incoming technologies, pricing, and the increase of demand.

Our main objective is to improve accessibility and prevent health catastrophes. To do this, we have to invest more. The challenge for the future will be to have appropriate costs and an acceptable quality of medicine and technology in a good system.

 

Having worked in the healthcare arena for the past 16 years, what is your personal motivation?

I used to work as a doctor in a rural area. This experience gave me a new impression and a new mindset. I truly believe that we have to take care of ourselves first, our family and friends. Additionally, one of my motivations is to try to satisfy everyone, the patient, the industry, the regulators and the government.

In the future, I hope that the entire healthcare value chain will be able to collaborate to build better human health. I have already seen a change in the situation. We are working more closely with private pharmaceutical companies to negotiate in order to find the proper price. The challenges come and go, but in the end, we still need to collaborate with each other to build strong relationships and a strong ecosystem.