6.

3 Decentralization
According to the Planning and Steps of Decentralization to Local Administration Organizations Act of B.E. 2542 (1999), only 180 out of 244 missions have been transferred to local government
organizations (LGOs). Such missions are those related to the promotion of quality of life including education
and public health. The transfer process is undertaken rather slowly as there are a number of practical problems
such as voluntarism to transfer, unreadiness of personnel to transfer, the kinds of personnel to be transferred
do not meet LGOs needs, and the concept for supervising the public health system as a single one for the
entire province, resulting in arguments against such a transfer. Regarding the financial decentralization, the
LGOs revenues have increased from 159 billion baht in 2001 to 414 billion baht in 2009, or the proportion of
LGOs revenue in relation to the government revenue has risen from 11.1% to 26.1% for the same period.

7. Situations and Trends of Technology

7.1 Technology Development
Advances in technology have been rapidly made resulting in innovations being developed and
having an impact on health development as modern technologies have been used freely in the treatment and
prevention of diseases, namely:
7.1.1 Information and communication technology (ICT). For health programmes, ICT has
been used for medical and health consultation including diagnosis and medical treatment with telemedicine
and diagnostic imaging technology.
7.1.2 Genetics and biotechnology. Rapid developments have been made in this area such as
digital-genomics convergence that integrates computer technology into biology. This might be a new dimension of curative care, moving from treatment towards prevention: adding disease-prevention elements to food,
soap or cosmetics, rather than taking medication orally for treatment of illness; organ transplantation (such as
for bone marrow); stem-cell treatment for patients with heart disease and leukemia; using recombinant DNA,
polymerase chain reaction (PCR) and genomics for producing a new vaccine and medicine; and farming of
genetically modified plants.
7.1.3 Material technology. New materials have been produced in response to needs in a
more efficient manner. In the field of public health, the technology has been used in producing medical
materials and equipment such as artificial bones, legs and feet for more efficient medical care of patients which
also helps improve their quality of life.
7.1.4 Nanotechnology. A more active role has been played by this kind of technology which
is believed to be used in producing a molecular machine comprising atoms to be inserted into the human body
for destroying cancerous cells or eliminating blood vessel-clogging lipids without surgery, or in producing a
small particle for carrying medication to the diseased part of the body without affecting other parts.

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Such technological changes have resulted in Thailand freely importing medical and health-care
technologies with no limitation or any mechanism for screening or inspecting the appropriateness of imported
high-cost technologies. Moreover, policy-makers lack evidence-based information for making decisions on
various technologies resulting in a lack of suitable selection process. And there is no law related to the
monitoring and control of the appropriate use of medical and health technologies, causing a rapid rise in
health-care spending, particularly for curative care for hospitalized patients. It was found that the costs of
medical supplies/equipment imports rose from 2,493.2 million baht in 1991 to 22,654.3 million baht in 2009.

7.2 Utilization Efficiency, Diffusion and Equality, and Access to Technology

The weakness of the public sector in controlling the use of high-cost technologies in a costeffective manner results in doctors prescribing diagnoses and treatments without due consideration for their
worthiness which negatively affects professional ethics and clients confidence. Moreover, an investment is
needed for personnel development and monitoring of the adverse effects of the utilization of high-cost
technologies. Unequal distribution of medical devices has also been noted, mostly clustered in major cities and
more in the private sector, not the public sector (see Chapter 6, section 3 on health technologies). This has
affected the access to high-cost health technologies of the poor and uninsured.

8. Health Behaviours
Risk factors of Thai people have an impact on their lives and are a national problem affecting the
countrys economic and social security. It is noteworthy that in all groups of countries, risk factors related to
behaviour clearly create a high burden of disease. In developing countries with high mortality rates, the top risk
factor is malnutrition; while more advanced developing countries (high income) face other risk behaviours of
alcohol and tobacco use, and over-nutrition (Table 4.33).

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