There is much to celebrate, but there will be many new challenges in Thailand's health care system.
Our recently completed research shows the health care system was among the most resilient and best-performing during the Covid pandemic.
Many countries saw access fall off and out-of-pocket payments by patients soar. This did not occur in Thailand. Patients continued to use the health care system during the pandemic and did not have to pay more as a result.
Another bright spot is the improvements in life expectancy among Thais. In 1950, the life expectancy at birth in Thailand was 50.8 years; by 2000 it had increased to 68.5 years and in 2022 the life expectancy at birth in Thailand was projected at 77.56 years.
While this is truly a cause for celebration, this demographic trend along with declining birth rates will put increasing pressure on the health care system. In 1960, less than 1 million people in Thailand were 65 years of age or older. By 2000, the 65+ population had grown to 3.8 million, and in 2022 totalled 11 million.
A Thai government report as part of the Paris Agreement in 2021 concluded that a decline in birth rate with a concurrent increase in life expectancy has shaped the population structure to quickly become an "ageing society" and that by 2035 Thailand's population is projected to become a "super-aged society".
According to United Nations projections, Thailand is considered one of the world's most rapidly ageing societies, with the population aged 60 and over expected to make up 30.2% of the total population by 2035.
This substantial and rapid restructuring of the population structure has the potential to exert a significant shock to the health care system if serious and comprehensive planning and action do not begin immediately.
The good news is that in 2001 Thailand sought to achieve universal coverage by extending health insurance coverage to the uninsured population to complement two pre-existing employment-based health insurance schemes.
As a result, Thailand is one of the few countries in the world with nearly universal (90+%) health insurance coverage. This provides a framework for a systematic and comprehensive approach to planning for this significant and rapid demographic transition to an aged population.
The type and volume of needed care for older patients are likely to be different compared to our existing system. For example, older patients use many more medical services. In the US, patients aged 18–44 see their doctor about 1.8 times per year while patients 65+ have an average 7.1 doctor visits per year.
Older patients also use different services, as they are more likely to have chronic, non-acute, non-communicable diseases. This requires a different set of medical services and a mix of physicians. For example, many more physician specialists will be needed of different types than are available today. Finally, there is growing research that early adoption of preventive health programmes such as monitoring and managing blood glucose levels before reaching age 60 can substantially delay the onset of disease as patients age.
As Thailand begins the new year, there is much to celebrate but many parts of the health care system will need to be re-evaluated to assess needed changes for the future, and planning and policy development needs to be debated and adopted to prepare for the future.
Kannika Damrongplasit is Faculty of Economics and Center of Excellence for Health Economics, Chulalongkorn University. Glenn Melnick is Sol Price School of Public Policy and Center for Health Financing, Policy and Management, University of Southern California. The mentioned research will be published in BMJ Global Health -- an open online journal of peer-reviewed public health and related policy.