Universal Healthcare: Comparison of Australia and Thailand's Health Status

Universal healthcare is a global health initiative supported by the World Health Organisation (WHO, 2019b). This essay will discuss universal healthcare and compare the health status of Australia to that of Thailand.

Part 1: Universal Health Care and Australia’s Healthcare System

Universal healthcare is defined by the World Health Organisation (WHO) (2019a) as consumers having access to essential healthcare services without facing financial adversity.

WHO (2019a) outlines five factors that are paramount to providing effective universal health coverage; the first of these factors being a well-organised healthcare system. A well-organised healthcare system entails a system that is run effectively and efficiently, delivering care through a person-centred care approach (WHO, 2019a). This includes spreading health awareness and encouraging the public to maintain healthy lifestyles in order to prevent illness and disease; detecting any conditions in a timely manner; possessing the capability to treat disease; assisting not only with primary treatment but also rehabilitation; guaranteeing palliative care that is delivered in a sensitive manner when required (WHO, 2019a). The second factor of affordability refers to healthcare being provided through a system that does not cause financial adversity to those who require services (WHO, 2019a). Universal healthcare does not call for all services to be provided free of cost due to the reality of no country being able to provide all these services at no cost sustainably (WHO, 2019b). What it does call for is protecting the public from possible financial crisis due to paying expensive medical bills, as well as making sure that everyone receives necessary healthcare regardless of their capacity to pay (WHO, 2019a). The third factor, capability to treat disease, refers to the availability of medicine and technology (WHO, 2019a). The fourth factor of health workers refers to an adequate volume of  “well-trained, motivated health workers” being readily available to deliver person-centred healthcare to patients (WHO, 2019a). The final factor of actions to address social determinants of health refer to the measures taken to tackle issues that impair people’s health and their capacity to access health services; this includes education, income and living conditions (WHO, 2019a).

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The Australian health workforce in 2017 comprised of over half a million practitioners that were registered and employed (Department of Health, 2017). This figure includes all health professionals including medical practitioners, nurses and midwives to name a few (Department of Health, 2017). Among these figures, 95,194 were medical practitioners of which 90,417 were registered clinicians (Department of Health, 2017). This puts the clinician to population ratio at approximately 1 clinician to 272 people. Amongst nurses over 267,000 were registered nurses (with around 22,000 having a dual registration with midwifery) compared to 51,000 enrolled nurses (Department of Health, 2017). This particular statistic shows there are many well-qualified nurses on staff across Australia. WHO (2019) also outlined the importance of not only well-trained staff but also “motivated” staff. According to a study by Skinner, Madison & Humphries (2012) 96% of nurses surveyed reported moderate to high satisfaction with their work and this figure was not reduced by facing moderate amounts of work-related stress. This shows that even when faced with adversity, Australian nurses still present as satisfied workers. Overall, the Australian workforce presents a large number of employees that are well-qualified and motivated to do their job to the fullest.

Part 2: Thailand’s Healthcare System

Since Thailand’s introduction of universal healthcare in 2001, the country has made tremendous steps in developing a healthcare system that by 2011 covered 98% of the population with affordable healthcare (Sen, 2015; George, 2016). Healthcare in Thailand previously only covered approximately one quarter of the population through insurance (Sen, 2015). Apart from this privileged portion of the population, the remaining citizens paid a fee out-of-pocket when visiting the hospital (George, 2016). However since the introduction of universal healthcare, the government financially subsidises the cost of employee salaries in hospitals as well as encouraging healthcare workers to work in unpopular rural regions through financial incentives (George, 2016). In Thailand, the annual cost of healthcare per person in 2011 was only $80 per individual, and this was largely funded through general income tax (George, 2016). Affordability in Thailand isn’t currently an issue but the journey to affordable universal healthcare has taken years (George, 2016). In 2001 when universal healthcare was introduced,  there was significant political pressure which made the task of implementing the new system difficult as it had to be done within a short amount of time (George, 2016). Astoundingly, by January of 2002, universal healthcare was implemented in every province of Thailand – however – this was only possible due to the foundations that had been laid in the years prior (George, 2016). These prior foundations included creating infrastructure to support the system which entailed building hospitals and clinics as well as training healthcare workers (George, 2016). Despite the challenges faced, Thailand still achieved the enormous feat of implementing universal healthcare nationally – therefore providing the people of the country with affordable healthcare.

Part 3: Australia vs Thailand Health Status

The Australian Health Performance Framework (AHPF) is defined by the Australian Institute of Health and Welfare (AIHW) (2019) as a navigation tool that supports the reporting of “Australia’s health and health care performance”. Using the AHPF, we can see that the health status of a country can be measured through the four domains of deaths, health conditions, human function and wellbeing (AIHW, 2019). In Australia the five leading causes of deaths are coronary heart disease, dementia and Alzheimer disease, cerebrovascular disease, lung cancer and chronic obstructive pulmonary disease (AIHW, 2018). Similarly to Australia, the leading causes of death in Thailand were also noncommunicable diseases (NCDs), although communicable diseases such as HIV remain a problem within communities (Jongudomsuk et al., 2015). The main NCD that was the cause of death in Thailand reported in 2015 was malignant neoplasms (cancer) (Jongudomsuk et al., 2015). This was followed by accidents and poisonings (Jongudomsuk et al., 2015). Although not listed as a leading cause of death overall – again similarly to Australia – circulatory disease is also found to be one of the NCDs responsible for the most deaths in Thailand (Jongudomsuk et al., 2015). Life expectancy in Australia for males is 80.4 years and for females 84.6 years, while Thailand has statistics of 70.6 years for males and 77.4 years for females (Jongudomsuk et al., 2015).

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In terms of health conditions, it is clearly seen that in both countries health conditions are quite heavily prevalent when looking at the main causes of death. In Australia on average each day there are 380 cancer diagnoses, 170 heart attacks, 100 strokes, 14 end-stage kidney disease diagnoses and 1,300 injury-induced hospital admissions (AIHW, 2018). Likewise in Thailand, there is an overall increase in the prevalence of health conditions also with conditions such as poorly-controlled chronic obstructive pulmonary disease (COPD), diabetes and heart failure being the most prevalent causes for hospital admissions that were deemed preventable at a primary health are level (Jongudomsuk et al., 2015).

After comparing the statistics and information for Australia and Thailand in terms of the domains deaths and health conditions, it is clear that while although the life expectancy in Australia is longer both countries have a high prevalence of disease. The longer life expectancy in Australia could also be attributed to Australia’s more available advanced medicine and technology and also could be due to the fact that Thailand’s universal healthcare system was not implemented until 2001, while Australia’s has been in practice for much longer. Both countries demonstrate statistics that suggest that there is still room for improvement in terms of universal healthcare. This is seen through the constant new diagnoses of health conditions in Australia (many in later stage of disease) and the increasing rates of poorly controlled health conditions contributing to hospitalisations in Thailand. As stated earlier, universal healthcare not only calls for treatment but early detection and prevention measures to be taken (WHO, 2019a). It is clear that in terms of the delivery of primary health care, further improvement needs to be taken in both countries. It is also important to note that Thailand is regarded as a poor country while Australia is considered a first-world country (Sen, 2015). In this regard it is quite an amazing feat that Thailand has accomplished implementing universal healthcare and improving the health of the population – although there is still room for improvement, the improvements they have already made are enormous.

Reference List

• Australian Institute of Health and Welfare. (2018). Australia’s health in 2018: in brief. Retrieved from https://www.aihw.gov.au/getmedia/fe037cf1-0cd0-4663-a8c0-67cd09b1f30c/aihw-aus-222.pdf.aspx?inline=true
• Australian Institute of Health and Welfare. (2019). Australia’s health performance framework. Retrieved from https://www.aihw.gov.au/reports-data/indicators/australias-health-performance-framework
• Department of Health. (2017). Health Workforce Data. Retrieved from https://hwd.health.gov.au/summary.html
• George, S. (2016). What Thailand can teach the world about universal healthcare. Retrieved from https://www.theguardian.com/health-revolution/2016/may/24/thailand-universal-healthcare-ucs-patients-government-political
• Jongudomsuk, P., Srithamrongsawat, S., Patcharanarumol, W., Limwattananon, S., Pannarunothai, S., Vapatanavong, P., Sawaengdee, K., & Fahamnuaypol, P. (2015). The Kingdom of Thailand Health System Review. Health Systems in Transition, 5(5). Retrieved from https://apps.who.int/iris/bitstream/handle/10665/208216/9789290617136_eng.pdf;jsessionid=9C2D181229BBD075CBCD39CB9DC4A5C7?sequence=1
• Sen, A. (2015). Universal healthcare: the affordable dream. Retrieved from https://www.theguardian.com/society/2015/jan/06/-sp-universal-healthcare-the-affordable-dream-amartya-sen
• Skinner, V., Madison, J., Humphries, J. D. (2012) Job satisfaction of Australian nurses and midwives: A descriptive research study. Australian Journal of Advanced Nursing, 29(4), 19-27. Retrieved from http://www.ajan.com.au/Vol29/29-4_Skinner.pdf
• World Health Organisation. (2019). Questions and Answers on Universal Health Coverage. Retrieved from https://www.who.int/healthsystems/topics/financing/uhc_qa/en/
• World Health Organisation. (2019). Universal health coverage (UHC). Retrieved from https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)