Research Strategy:

(I) Healthcare structure and payment responsibility:

• Thailand utilizes a Universal Health Coverage (UHC) system that is government-funded via a tax-financed system. The Ministry of Public Health (MoPH) overseas the system and UHC is funded through the Department of Medical Services.
• The main infrastructure consists of the Public health sector (UHC), the Private health sector, and the Non-Profit Health Sector (NGOs). The Private sector, using private insurance, is popular with ex-pats who would otherwise be enrolled in the UHC and contribute via deduction from salary.

• UHC is organized into three tiers based on income and employment. A simplistic view is described in the figure below.

• The Civil Service Medical Benefits Scheme (CSMBS): formal public and private sector including dependents. This scheme is funded through the Finance Ministry. Private sector employees can utilize the Social Health Insurance scheme which is managed by the social security office of the Labor Ministry.
• Social Security Scheme: Informal sector including middle class or borderline impoverished. This is funded through the Labour Ministry.

• The Universal coverage scheme: Impoverished families. This is funded through the MoPH.
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(Ia) Key Government Bodies:

• Ministry of Public Health: MoPH is responsible for overseeing all disease prevention and control, medical care services and procedures, rehabilitation, and healthcare promotion. The organization is the core agency that manages the health care systems in Thailand.
• Ministry of Labour: Oversees labor administration and protection, employment, and skill development. The Ministry is also responsible for the social security scheme.
• Ministry of Finance: Oversees government taxation, treasury, properties, and revenue-generating organizations. This Ministry funds the CSMBS scheme.
• Health System Research Institute: oversees and promotes research. The government agency also aids in health policy formation and reform. The HSRI oversees five affiliate institutes: Hospital Accreditation, National Health System Reform, The Prospective Cohort Study of Thai Children, International Health Policy Program, Central Office for Healthcare Information.
• Thai Health Promotion Foundation: As the name implies this gov organization primarily sponsors and creates promotional plans aimed at a variety of health issues within the Thailand communities. The plans include tobacco, alcohol, and substance abuse control, road safety and disaster, health risk, health promotion for vulnerable populations, health community strengthening, child, youth, and family health, and health promotion within organizations. The organizer works at both the community and government levels to change existing policies to promote various health plans. The organizer also educates the public on various healthcare plans.
• National Health Commission Office: This gov organization aims to bring together government, academia/research, and private sector to influence public health policies in Thailand. This organization appears to have much contact with the World Health Organization.
• Emergency Medical Institute of Thailand: Responsible for developing the Emergency System in Thailand including ensuring the system is accessible to all income levels. The EMI works on both health-related emergencies as well as disaster preparedness.

II. Liver disease management and patient options:

• Though liver diseases are a common issue in Thailand the most worrisome is Hepatocellular Carcinoma (HCC). The treatment options include surgery to remove masses, radiation, liver transplant, transarterial chemoembolization, chemotherapy, tyrosine kinase inhibitors. Surveillance via ultrasound has also been found to decrease mortality and thus is a common diagnostic/management option.
• Patients who are diagnosed with HCC are normally given priority via the UHC system due to the mortality rate and prevalence.
• There is an association between HBV/HCV (hepatitis) infections and the development of HCC specifically due to liver cirrhosis from hepatitis infections. This has lead to changes in treatment options where the focus is given to treating HBV/HCV infections with pegylated interferon-gamma, ribavirin, or lamivudine.
• According to one study, patients have little say in which physician they choose nor treatment options. This has caused some patients to seek private hospitals rather than public hospitals due to enhance the freedom of choice in their healthcare decisions. They also experience long waiting times and limited service out of office hours.

III. Resource distribution:

• Thailand has 2.4 health specialists per 1000 people working in public health facilities. Physicians slightly favor hospitals in more wealthy areas in contrast to rural areas but the distribution of physicians was more concentrated in lower-income areas. Overall the distribution of health care professionals is equally distributed.
• In terms of the types of physicians, there is a low ratio of hepatologists: 1:6000 for patients with non-alcoholic steatohepatitis and even less for the general population (1:130,000).
• In Southern Thailand, the ratio of patients referred to Radiation Oncologists is 360:1.
• District hospitals have a higher amount of GPs than regional or provincial hospitals and all regions have more specialists than GPs. For example, the central region has a ratio (GP: Specialists): 1: 27.8, 1:17.5, 1:13.0, 1:11.8. This means that the distribution of GP to Specialists is skewed towards more specialists in Thailand and some argue that the shortage in GPs could lead to more issues not just for disease management (i.e HCC) but for the stability of the UHC system.