Universal Health Care Eases the Impact of Diabetes in Thailand

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If you have to have diabetes, you can consider yourself lucky if you happen to live in Thailand.

That’s because in 2001, the Thaksin Government introduced a universal coverage scheme with the aim of ensuring equitable health care access for even the poorest citizens, moving away from a system funded primarily by out-of-pocket payments to one funded by a mix of taxes and insurance contributions.

For a flat user fee of 30 Baht per consultation, or for free for those falling into exemption categories, every scheme participant may access registered health services.

The exemption categories include children under 12 years of age, senior citizens aged 60 years and over, the very poor, and volunteer health workers. The functioning of these exemption mechanisms and the effect of the scheme on health service utilisation among the poor is controversial.

The result is that those Thais who have diabetes – nearly 10% of adults in the country’s 68 million residents – have ready access to the medicines they need not only to survive, but to stave off complications.

“Under the national health care scheme, they have a system where anybody who has the need for treatment is offered the treatment free of charge,” says WHO Public Health Administrator Dr Nima Asgari-Jirhandeh. Local health centres routinely test and treat patients for diabetes and other diseases. “If need be, they are referred to a district hospital for further treatment,” he adds.

Diabetes can affect children and adults

Diabetes can affect people of all ages, yet – if properly managed – need not affect a person’s ability to live a full life. Khun Ni, 26, has type 1 diabetes and knows that well.

“I’m a beginner mum. There’s many things to practice,” she says as she cradles her month-old daughter, Mi, during a visit to Siriraj Hospital in central Bangkok for her weekly diabetes check-up. “One thing that I’m very happy for my child is that she has no diabetes and I’m able to breastfeed her.”

In fact, it is exceedingly rare for someone to be born with diabetes. But cases of type 1 diabetes – which used to be called juvenile-onset diabetes – often occur in childhood but can also occur among adults. With the diagnosis of type 1 diabetes come increased needs.

For grade-schooler Sip, living with type 1 diabetes means depending on his school teacher to intervene when his blood sugar goes too low. Low blood sugar can lead to confusion and, if not treated, can result in loss of consciousness, convulsions, even death.

“Sip has a good teacher,” says his mother, who ensures the teacher has a sweet drink to offer her son at the first sign of low blood sugar. “I’m very glad with her help.”Kim, 16, participates in a traditional masked dance called Khon, and travels with other troupe members for performances.

“In the beginning, I wasn’t sure if my condition would make comfortable the trip,” he says. “But I prepared well and never forget the medicine box.”

Universal health coverage benefits people with diabetes

Thailand, too, has prepared well. Though health costs represent less than 5% of Thailand’s Gross Domestic Product, vials of insulin are available from primary care facilities without charge. Blood-sugar test strips are not free, but a person with diabetes can get his or her blood sugar checked at their local health facility. And the measure of blood-sugar control over the prior 3 months, a simple test called HbA1c, is offered without cost each year.

Screening for cataracts, which are more common among people with diabetes, is offered to people age 60 and older.

WHO helps mitigate the long-term risk of diabetes in Thailand by supporting government tobacco-control efforts and participating in projects that push Thais to increase their physical activity.

WHO has also partnered with national agencies on a host of health promotion and prevention issues, such as tackling obesity and reducing salt intake.