Determinants and Fiscal Implications of Public Health Expenditure in Thailand, 1994–2023

Abstract

This study is the first in Thailand to quantitatively assess three decades of government health spending using an integrated model. It aims to identify the long-term key factors driving public health expenditure, with a focus on fiscal sustainability amid rapid population aging. Using national-level time series data from 1994 to 2023, multiple linear regression was applied to examine the relationship between public health expenditure (as a percentage of GDP) and key drivers: population aging, GDP, public revenue, inflation, unemployment, medical technology imports, political cycles, and the COVID-19 pandemic. Diagnostic tests for multicollinearity, heteroscedasticity, and autocorrelation were conducted, with the Cochrane-Orcutt method confirming model robustness. The results show that population aging (p<0.001) and COVID-19 years (p<0.01) are significantly associated with increased government health spending. In contrast, GDP is negatively associated with spending in normal years (p<0.01) but reverses during crises, reflecting structural shifts in fiscal response. Public revenue and unemployment (p<0.01) show significant negative effects. Inflation, medical technology imports, and election years were not statistically significant. The findings highlight that aging is the most consistent long-term driver of fiscal pressure in Thailand’s health system. Policymakers should prioritize invest in geriatric and chronic care, shift from hospital-based to preventive and long-term community care, and build resilient financing mechanism to safeguard access to essential care. Future studies may consider using data on telehealth and medical technology to better understand their role in shaping health expenditure and strengthening system resilience.