Background: Substance abuse has been an important social and public health problem in Thailand for decades. The National Household Survey on Substance and Alcohol Use in Thailand, which has been conducted 5 times, shows that substance abuse has steadily increased. Extrapolated country-wide in recent data, the estimated number of people who had ever used at least one addictive substance at some time in their life was 3,531,436 or 7.30% of the total population aged 12-65 years. Krathom, Methamphetamine, Ice, and cannabis were the most prevalent substances of abuse.

Methods: Historical documentation, policy reports, and group discussion with key professionals who work in the substance abuse community were used in this study. The objectives of this study were to complete a document review, determine the effectiveness of previous  Thai illegal substance measures, and consider options for the future.

Findings: Although the Thai government has dedicated human resources and an enormous budget to controlling drug use, substance abuse has become a more severe problem when compared with previous years. There are many organizations trying to create and develop programs, measures, and policies for dealing with substance abuse. These policies usually have had loopholes which resulted in corruption of officers, undercutting the public health value, creating dilemmas for impoverished families experiencing drug abuse, ignoring human rights, and creating a negative attitude among society toward drug users. Barriers to establishing successful drug abuse policies in Thailand include limited access to data and data management, a lack of efficiency and cost-benefit measures and policies, and limited use of evidence-based research.

Conclusion: To address illegal substance abuse in the future, the stakeholders should work to reduce the incidence of new sellers and the prevalence of new users. This would result in diminishing the health impact and criminal aspect of illegal substance use, increase social awareness, and motivate communities to participate in managing this issue. To reach these goals, the policy should concurrently aim at curtailing the supply of illicit drugs and reducing their demand. The strategies relevant to drug policy consist of primary prevention, services for chronic drug users, supply control and regulations, prescription regimes, and the use of criminal sanctions, especially consideration of decriminalization of krathom use.

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The single-payer NHI program, operated by National Health Insurance Administration (NHIA), was established through integrating three existing social insurance schemes and extended the coverage to the then uninsured 43% of the population. Taiwan NHI offers comprehensive benefit coverage that includes ambulatory care as well as inpatient services. On the service side, Taiwan has a market-oriented health care delivery system, reflecting its free-enterprise economy, as evidenced by the pluralistic organization of health services. Hospital ownership is mixed where public hospitals only account for 35% of all beds. Sixty-three percent of allopathic physicians are salaried employees of hospitals; the remainder, fee-for-service private practitioners. Over the years, hospitals have developed large outpatient departments and affiliated clinics for primary care in order to maintain inpatient volume and compete with private practitioners who operate free-standing clinics with beds. There is no gate keeping mechanism and the insured essentially enjoy complete freedom of choice which is likely a source of overuse.

NHI revenue mainly relies on payroll-based premiums, supplemented by a levy on non-payroll income and government subsidies. In 2013, NHI spent roughly NTD 492 (USD 16.4) billion on medical claims, accounting for approximately 52% of national health expenditures, and in total, Taiwan devoted 6.6% of GDP to health.  As a single payer, NHIA has effectively exploited its market power to experiment with various payment reforms in its 20-year history.  NHIA gradually set up separate global budgets for dental services, Chinese medicines, primary care services, and hospital services since 1998.  The annual growth rate of the total NHI budget is negotiated among stakeholders. 

Our seminar will look to the future with presentations on innovative healthcare delivery models and coping strategies by private hospitals.