Public versus private health care provision in the northeast of Thailand

Abstract

This thesis is a comparative study of public and private health care provision in Northeast Thailand. It main objective is to explore the question of whether private health providers are more efficient and effective than their public health counterparts The thesis also examines equity concerns raised by the growth of private sector medical institutions The study commences by describing the changes in health problems, health policies and health care delivery in developing countries and Thailand that have led to the development and growth of private health care. This is followed by detailed consideration of the Northeast of Thailand including the socioeconomic context, health indicators and health delivery systems development paying particular attention to private sector growth. The remainder of the thesis is comprised of an empirical study of selected public and private sector hospitals in Northeast Thailand and an analysis of the results Much of the data was collected from questionnaires delivered to patients and staff in the study hospitals. The major findings include roughly similar levels of patient satisfaction between public and private hospitals; patients utilizing public hospitals often had no choice of which institutions to use, and the average incomes of patients attending private hospitals were above those of public hospital patients. There was undoubted inequity of access to private sector facilities. Data gathered from hospital staff showed greater levels of satisfaction with staffing levels and quality in private hospitals than in public ones. Salaries were more compressed in public hospitals due to central government rules than in private hospitals whose management was based on market considerations. However, higher salaries were paid to skilled professionals in the private sector. Public sector hospital management was typically bureaucratic with central government guidelines and decisions determining many aspects of hospital organization. It was found that comparison between public and private hospitals was complicated by the different missions and activities of institutions in the two sectors. The thesis concludes by arguing that the mixture of public and private health care providers has contributed to a more competitive atmosphere which has encouraged greater concern with quality and efficiency in the delivery of health services in Thailand.

Date of Award	2002
Original language	English
Supervisor	Mark Turner (Supervisor)